The PCOS Diet

Most women treat PCOS with medication. Usually they do so with birth control pills or with blood sugar regulating meds. However, neither of these options ever solve PCOS.

Drugs may cover up symptoms of PCOS in the short-term, but they are completely ineffective for long-term healing.

But there is one secret key to effective change.

It is a PCOS diet.

Here’s why, how, and what to do about it.

The PCOS Diet: Why

PCOS (read my introductory post “what is PCOS” here) stands for poly cystic ovarian syndrome. It is the condition of having multiple small cysts on the ovaries. It is usually accompanied by elevated male sex hormone levels and irregular menstrual cycles.

Markers of PCOS include acne, oily skin, facial hair, balding, difficulty losing weight, low libido, and missed menstrual cycles and infertility. Not every woman who suffers from PCOS has all of these symptoms, but all have at least a few.

These symptoms are not a result of the cysts on the ovaries themselves. Rather, they are a result of a hormone imbalance in which male hormones are elevated over female hormones.

When doctors proscribe medication for PCOS, they typically have two options:

One is birth control pills. These pills contain progesterone and (usually) estrogen in them. These pills help control the symptoms of PCOS because they increase progesterone and estrogen levels in the blood. Doing so helps restore proper balance between male and sex hormones. The problem with taking these pills is that the underlying hormone imbalance continues to exist. Once you come off of the pill, the chances are close to certain that your PCOS symptoms will come back.

Another is blood sugar regulation. The primary pill used for this is metformin, which I have written about at length here. Metformin sometimes helps (though not always, not all PCOS cases are the same). Even in cases in which it does help, however, it does not heal the underlying problem.

The important thing to know about PCOS is that it is caused by an underlying health condition. If you take medications that cover up symptoms, you are still left with the underlying health problem. In many cases of PCOS (though not all) this is an insulin problem, and may also be a gut problem, or a thyroid problem. All of these problems can cause many other symptoms and diseases in the long-run. In fact it is almost certainly guaranteed to.

The only way to be free of all of these health problems is to make the dietary changes necessary to correct hormone imbalance and heal underlying health conditions.

The PCOS diet: How

I wrote an extensive post about the causes of PCOS here (and an even more extensive book about it here). For a real quick recap, this is what I said:

PCOS is far more complicated than most medical professionals and websites would have us believe. They tell us that PCOS is only a problem of high testosterone and insulin levels.

But PCOS is caused by so many more things! It is also caused by hypothyroidism, by leaky gut, by birth control pill usage, by inflammation…. all of which are problems that can be overcome with dietary changes.

The PCOS diet I describe here helps account for all of those things. I will mention below which specific aspects of the diet are more helpful for different underlying conditions – though all of the points of advice are helpful to know about.

The more you know about your PCOS and what has caused it, the better. That way you can better tailor your diet and healing plan to your needs. I wrote a manual exactly on how to figure out your PCOS that you can read about here. You can also check out this post on PCOS treatment options.

The PCOS Diet: Foods to Eliminate or Limit

From a physical standpoint, it may be best to completely eliminate the following foods from your diet. However, I recognize that this is not necessarily feasible, especially if you have an ambivalent relationship with food and think that an overly-restrictive diet will do you more harm in the long-run.

So I advise you to consider these guidelines as firm guidelines you choose. Choose to focus on the healthy foods and to avoid the less healthy foods. Don’t force or punish yourself. Make it a choice – and it will be all the easier to adhere. You may choose (for any number of reasons) to deviate from the guidelines from time to time. Just know also that it’s best to focus on the healthy foods as much as possible.

Processed foods

Perhaps it goes without saying, but this is so important I will say it anyway:

Foods that come in colorful bags and boxes have most likely been “manufactured” to some extent, and contain any number of unhealthy compounds. Trans fats and partially hydrogenated oils may be some of the worst, though all the added sugar in processed foods gives them a run for their money.

Foods that you wouldn’t even expect to be bad are often full of things that aren’t good for you. Breakfast cereals, for example, are usually fortified with folic acid. This was intended to be helpful for pregnant women – but it now instead has been linked to several forms of cancer.

If you instead eat one serving of spinach every day, you would get your daily requirement for folate which is far healthier for you than the chemical altnerative folic acid made in laboratories.

Take a look at the ingredients in whole wheat bread. In addition to being full of gluten and other harmful wheat proteins, for most brands, there is a high amount of sugar and even partially hydrogenated soybean oil in the bread.

Processed foods cause PCOS because they cause nutrient deficiencies and inflammation. They mess up metabolism and make it hard for the body to healthfully detox and metabolize food. Removing them from the diet can do wonders for women with PCOS.

Sugar

I am a perfectly good fan of fruit, potatoes, starches, and other natural plant carbohydrates. Sugar, on the other hand, in sweets, in soda, in sauces, and in just about everything else from restaurants or packages in grocery stores, is incredibly bad for women with PCOS.

Sugar causes insulin levels to spike, and insulin causes the ovaries to produce testosterone. Therefore many women find that there is a direct relationship between how much sugar they eat and how bad their PCOS symptoms are at any given point in time.

Sugar is not the only thing that can cause insulin levels to go haywire. Having inflammation or IBS or other gut problem can also cause dysregulated insulin levels. But sugar is most definitely one big potential bad guy that should be eliminated (as much as possible).

Seed oils

What’s a seed oil? A seed oil is probably the oil 95% of the food you have eaten in your life has been cooked with, especially if you often eat at restaurants.

Seed oils are used in processed foods and by restaurants because they are cheap nd don’t have a unique flavor, which makes them easy to use in any food product.

Unlike most bloggers in the paleosphere, I don’t think it’s necessary for everybody to give up grain products 100%.

However – if you have a gut issue, an insulin issue, or most especially an autoimmune disease like Hashimoto’s Thyroiditis like many women with PCOS do have, you probably do need to eliminate grains at least for a while.

And even for those of us who do not have any of those conditions, grains are still not optimal. The proteins in grains (gluten is one but not the only one) can be harmful to the gut lining. Certain molecules in grains bind with nutrients in the gut and carry them out of the body with excretion. They should not be the staple of anyone’s diet.

Consider eliminating grains for at least a few weeks and see if that helps you! Some women I have worked with have found that eliminating grains was the most important thing they did for their healing. (Though others of course had different problems and needs.)

By grains I mean all bread products, pasta, breakfast cereal, bagels, sandwiches, pizza, etc. Grain-type things that are okay in my book are rice, quinoa, and occasionally corn and oats (though be sure they are gluten free).

Dairy

Dairy is complicated. Some women need to remove it for PCOS and others do not. This is another food, like grains, that I recommend experimenting with. Remove all dairy – milk, yogurt, cheese, cream, and butter (though ghee is fine since it is clarified!) – for at least 3 weeks and monitor if you experience any changes in your symptoms.

Some women need to eliminate dairy because of its harmful effects on the gut. Others find that doing so helps with symptoms of PCOS like acne because dairy is simply a food that has a lot of male-type hormones in it.

If you have an autoimmune disease or IBS….

If you have an autoimmune disease like Hashimoto’s Thyroiditis or Irritable Bowel Syndrome (or other gut issue) which can all contribute to PCOS, I recommend considering eliminating legumes like beans and peas, nuts, and also the nightshade vegetables tomatoes, potatoes, eggplant, and pepper.

Your best bet as a guide in doing so is Dr Sarah Ballantyne, who’s written the book on autoimmunity and diet. You can find the book here.

The PCOS Diet: Foods to focus on

That may seem like a lot of food to eliminate! No processed foods, no oils, no sugar…. well, really all this eliminates is processed food! (If you get smart at reading labels you can still include some foods that come in bags and boxes… I talk about how to do so in this book.)

All that’s left having been eliminated for sure is grains, and possibly, though not necessarily, dairy.

Then you are left with a literal bounty of fresh fruits and vegetables, healthy cooking fats like olive and coconut oil, and all the animal products you might ever want, from eggs to ribs to bacon and back.

Vegetables

Vegetables are awesome. All of them. They are rich in B vitamins, vitamin E, vitamin C, and many other antioxidants.

Try to have at least one serving of greens like kale, spinach, chard, or broccoli every day. More often than not, cook the greens, as this reduces a potential threat they might pose to your thyroid gland.

Starchy vegetables

Starchy vegetables like potatoes, sweet potatoes, yams, cassava and taro are great choices for meeting your carbohydrate needs (which I consider to be at least 100 grams a day).

Women who struggle with insulin and who are type I PCOS may not want to have a TON of starch, but they should still have at least some carbohydrate – at least 100 grams a day! Women who are type II PCOS and struggle with low hormone levels may instead want to have a LOT of carobhydrate, somewhere around 2 or even 300 grams a day.

Fruit

Fruit is also awesome! Fruit is also full of antioxidants and vitamins. As with starches, women who struggle with insulin and who are type I PCOS may not want to have a TON of fruit, but they should still have at least some carbohydrate!

I especially love berries, cherries, and other dark fruits like plums for great antioxidant content. Antioxidants improve detox and lower inflammation, which is crucial for overcoming PCOS.

Eggs

Eggs are super healthy super foods! They contain all of the building blocks for a single organism in them… so they contain a lot of nutrients we can’t really get anywhere else!

In particular, eggs are rich in choline, which supports liver health, helps lower triglyceride levels, and which can help reduce inflammation and metabolic dysfunction.

For women with all types of PCOS I recommend trying to eat two eggs (and the YOLKS, which are the parts with all the nutrients in them) a day.

Seafood

Seafood, particularly wild caught fatty fish like salmon (a great salmon snack here!) or trout, is great for women with PCOS. Not only does seafood contain high levels of good vitamins like vitamin D and iodine, but it is also the only rich source of the super healthy omega 3 fatty acids EPA and DHA in the diet.

Aim for one pound of fatty fish like salmon every week. If you cannot get that, consider taking this cod liver oil supplement. This is the highest quality and most nutrient dense fish oil available in the world today (not exaggerating).

Seaweed

Seaweed is awesome for PCOS because it contains lots of trace minerals in it, including iodine and selenium, which are great for supporting thyroid function.

For the sake of thyroid health, be sure that if you eat seaweed (here’s a super tasty paleo-approved seaweed snack) or supplement with kelp to eat about 10 brazil nuts (raw organic here) a week, since those are high in selenium and the seaweed is higher in iodine. It is crucial to get both iodine and selenium in the diet as the thyroid needs both in order to function optimally.

Organ meats

Organ meats are some of the healthiest foods around! Did you know that liver contains 20,000 times the vitamin A of the normal vitamin A “superfoods” carrots? It does!

Aim for about one pound of liver consumption a month. If you don’t like liver (but you should, it’s amazing), try 10 capsules of this grass-fed desiccated liver supplement.

Grass-fed animal products

Grass-fed cows, bison, pork, and other animals are great sources of protein and fat, rich in the B vitamins you need to support detox.

Butter from grass fed cows is also great -particularly ghee, which tastes like butter but is safe for everyone (even those of us with autoimmune diseases) to eat.

Great plant fats: Avocado, Olive oil, Coconut Oil, Palm Oil

Olive oil is an amazing plant fat. It is great at low temperatures (but can go bad and be unhealthy at high temperatures), so use your olive oil mostly for cool foods like salads.

Avocadoes are super healthy and high in vitamin E, which can help promote progesterone production, so this is a definite must for women who like their taste buds and have PCOS. 🙂

Coconut oil is anti-microbial and great for fat-burning, as its a fat with a special molecular shape. I already mentioned that this is my favorite coconut oil. It’s great and super healthy for cooking, and fabulous in both sweet and savory dishes.

Red palm oil is another option that is good for high heat cooking if you do not particularly love the taste of coconut oil. Here is the tastiest, in my opinion.

Fermented foods

Fermented foods are great for PCOS because they are excellent ways to help support gut flora health, which is crucial for overcoming insulin resistance, cooling inflammation and balancing hormone levels.

Here are some of my favorite fermented foods and great links to get them online: kimchi (korean fermented cabbage), kombucha (fermented tea-careful though because it has caffeine!), and coconut-based yogurt.

The PCOS Diet: How to Eat it

Having a list of foods is all well and good, but you are probably wondering at this point how much and when you should be eating these foods.

Unfortunately, the answer to that question vaires based on which type of PCOS you have. For example, in the manual I wrote (check it out here) on overcoming PCOS, I recommend different amounts of carbohydrate for type I or type II PCOS. I also recommend different meal timing. For type I PCOS, I recommend eating in 3 meals, or perhaps 4 including a snack, every day. For type II PCOS, it is often helpful to eat more frequently than that.

In general, however, here are some good guidelines to follow:

Moderate protein:

A healthy protein level for women with PCOS is between 50 and 100 grams of protein every day. This is the equivalent of 2-4 cans of fish a day (for sizing purposes), which is also roughly about 3 palm-sized servings of meat a day, 0.5-1.0 pounds of meat, or 8-16 oz of meat.

Many women with PCOS – there are no good numbers out there, though in my best estimate is perhaps between 40 and 50% – have a tendency to have elevated homocysteine levels, as a result of carrying the MTHFR gene mutation. Homocysteine is a by-product of protein metabolism, as well as the body’s detox processes. One of the best things you can do to help keep homocysteine levels in check is eat a moderate protein diet. More than 100 grams/day is probably not optimal for a woman carrying the MTHFR mutation.

(Another thing you can do is take a high quality methylated B vitamin supplement. This methylcobalamin (B12) is good. This methylcobalamin with 5-MTHF is even better for some because the 5 MTHF even better helps support the body’s detox methylation pathway. Always start with a low dose and take it in the mornings since B vitamins can be energizing!)

Plenty of healthy fats

It is optimal to eat at least 36 grams of fat each day, which is about 12 grams of fat per meal (or approximately 100 fat calories). Fat is important for helping the body absorb nutrients, as well as serving as a building block of fatty tissues in the body, like the brain. It also helps keep blood sugar levels stable, which is important for keeping insulin (and therefore testosterone) levels in control.

Aim for one tablespoon of fat at very minimum with every meal.

Plenty of fiber

There is no need to supplement with fiber, or to try to eat high fiber cereals. A diet rich in vegetables and fruits will having plenty of its own natural fiber to give you.

Fiber is great for PCOS because it helps moderate blood sugar responses to meals (it slows down absorption in the intestines), and also because it helps feed gut flora, and also because it helps the body keep digestion moving along at a healthy pace.

At least 100 grams of carbohydrate a day

Some women (usually those who are overweight and/or have insulin resistance issues) find that a lower carbohydrate diet helps manage their PCOS. In this case, they should eat carbohydrate on the lower end, but probably not go much below 100 grams a day. I see far too many women suffer ill effects from a low carbohydrate diet to advocate a very low carb diet for any significant length of time.

Other women should definitely try to stay above 100 grams of carbohydrates like fruit and starchy vegetables every day.

For a lot of people in the paleosphere, 100 grams sounds like a lot. But that’s really just 1/2 a sweet potato or one apple with every meal – a much lower carbohydrate intake than the general population eats.

And I personally eat approximately 250-300 grams of carbohydrate each day – so you are probably lower than I am in carbs!

The PCOS Diet: Healing naturally and flexibly

I have not laid out a specific diet plan. I have not given you meal times or necessary serving sizes.

Rather, I have listed foods that are important to avoid, and foods that are important to focus on, and some rough guidelines for making sure you get enough of the things you need. After you meet these minimum requirements, you can fill in the rest with whatever your heart desires.

This diet is a very nourishing one. Choose a variety of foods from the vegetables and fruits, healthy animal products and healthy fats I list, and you will be eating a diet that is highly nourishing, that reduces inflammation, and that helps support hormone balance.

The best part about it all is that it is long-term, and long-lasting. Medications cannot do that for you. Medications are like band-aids. they might cover up PCOS, but they do not solve it.

The diet I describe here, which I have used personally and used with countless clients all over the world, has literally saved so many of our lives. It gave me my libido back. It cleared my skin. It gave me my fertility back.

The PCOS diet really is a secret to healing – so many women are still missing out on it. So many women still don’t know the amazing effects these easy, natural dietary changes can have on their lives.

The PCOS diet is an incredible tool for overcoming PCOS for good, especially if you’ve figured out your own type of PCOS and what caused it.

You can figure out what caused your PCOS, and tailor this PCOS diet specifically to solving that problem, with the help of my manualfor overcoming PCOS, PCOS Unlocked: The Manual.

18 Comments

Kim
on June 4, 2015 at 1:04 pm

I mostly agree. This is wonderful information and a good reminder that I shouldn’t do whatever Dave Asprey or Jimmy Moore tell me to do (nothing against them). My only issue is the addiction to the carbs, even when they are whole foods. I will eat ALL of the rice and potatoes I can get my hands on in one sitting. And then I feel awful. Have you written about this topic at all?

Thank you for all you do and share. You have helped with my mindset quite a lot since I’ve started reading your work.

Do you have any gut symptoms? That’s a good one. Also: have you ever taken antibiotics? That may be another. Also: do you have acne or other skin conditions? Do you think you may have any auotimmune diseases? Any inexplicable symptoms? Those could all point towards a leaky gut or low gut flora count.

I too have a past that includes both HA and PCOS. My doc did not know which label to give me, so she mentioned both and left it at that. I’ve finally started getting my period back a year ago after being without it (except for the rare, spontaneous ovulation and period) for over 20 years! I’m excited to see different dietary info here than the standard PCOS diet out there. As a thin “cyster” with a HA past, going really low carb and strictly “Paleo” was just terrible for me. I never “fat adapted” and rather was a shaky, anxious, hypoglycemic mess with no help in my symptoms or cycle. I decided to keep my clean eating and add back in my non-gluten sources of carbs, and viola, my period returned!!! It was not exactly that simple, as I’ve done quite a bit of stress management, grief work, mind/body work (and supplements) along the way, but that did really seem to give my body what it needed – clean, balanced food, free of junk and a heart/mind that no longer perceived the world as unsafe. Over this past year, I’ve returned back to the person I am deep down inside and, for lack of a better word, have my mojo back. Now, to maintain this for life. No big deal, right? 😉

I’m not sure if it’s correlational or causal, but I actually got my period back when I *stopped* eating paleo. I hadn’t had a period for 9+ months. Eventually I began eating tortilla chips…drinking beer…then eating bread etc. Coincidentally (?) I got my period back a couple months later. That said, I credit its return mostly to gaining 5-10 pounds and eating better for my blood sugar + adopting a more stress-free lifestyle.

This article is awesome. I just got back from my Dr who gave me an Rx for Metformin. I’m 5’4 and 142 pounds, so not overweight, but I do have extra, annoying weight around my midsection and my labs and lack of period all point to PCOS. Anyway, I hate taking any meds and felt so annoyed at the thought of taking Metformin, so I’m so glad I found your blog. Going to try your suggestions and see if that helps my symptoms. One question. You didn’t mention coffee. I’m hoping it’s because I can drink as much as I want, but I’m curious your thoughts. Thanks again!

Hi there, I am going on 24 yrs old and i have PCOS, diagnosed when i was 18, hypothyroidism, insulin resistance, etc. but i am a huge sweet/chocolate freak. is there anything you recommend for the sweets, chocolate pudding/milk shake i could make, also i do have sugar free russell stover candies around when i get that urge, i cannot stand dark chocolate either.. just wondering if you have any suggestions. thank you!

I am pretty sure I do NOT have PCOS, but I could be wrong. All I know is, I consistently get ONE LARGE cyst on my ovary each month around ovulation. Sometimes it hurts for a few days, sometimes almost the entire month, but it’s worst around ovulation time. At times it is very painful and I can feel how large it is by how bloated and inflamed I feel. I also feel that it makes my period cramps worse.

I see a Nature Path doctor, who has me on some herbs that sometimes help, but I’m stuck and haven’t been able to completely get better. This doctor says I have excess estrogen, which causes my cyst (as well as joint pain).

A few other random facts, I’m 26, underweight (no eating disorders), come from a naturally thin family, but have always had a pretty regular period, and have acne (especially around chin and jawline).

I’m guessing and hoping that this type of diet would help with my problem, even if it’s maybe not PCOS? I’d appreciate any feedback!

Nicely written, I do have one problem with paleo which is the unneccesary consumption of animal products. There is a great deal of pain and suffering involved in getting a piece of meat (a dead animal on your plate and in your body). Mind you the stress an animal experiences will be absorbed in your body. I personally prefer not to participate in such cruelty.
In addition, the eggs mentioned contain loads of hormones due to the food they are fed. Half of all eggs that are bred (to have more hens to produce even more eggs) are male and therefore ‘useless’ in the industry and so either gassed, shredded or suffocated. Highlypainful and unnecessary death. The hens that get to live and are made the lay eggs suffer a great deal. They are so exhausted by the excessive egg laying due to the alteration of light and medication they literally die because all life is sucked out of them. Chickens can get 10 to 15 years of age, as a laying hen they don’t see their third year.

All in, I would opt for a paleo style without all the pain and suffering so no eggs, no meat.
Plant-based is the way to go.

While some people are carb-tolerant enough to eliminate sugar and heal their PCOS, not everyone is. Low-carb diets don’t cause PCOS, for heaven’s sake. Changing to a low carb way of eating is why I now have three beautiful daughters. I ate 95% vegetarian and very little sugar, but even Metformin+Clomid couldn’t get me to ovulate. I am incredibly sensitive to carbs. PCOS is caused by insulin resistance. Insulin resistance comes from an overabundance of insulin. Insulin is released in direct response to carb load. It’s not rocket science. In fact, it’s well-founded biology.

Thank you for the info. I quit the pill last winter and it took me 7 months to see my period return. I don’t know if it came back because i increased my fat and protein intake or just due to time, but either way now I’m on cycle 3 and my gyn confirmed I’m not ovulating. She said I should go back on the pill to regulate it since the excessive bloating and acne are bothering me but after the amenorrhea I’m so scared to go back on it. I’m 111 lbs and 5 ft 2 without much muscle and no insulin resistance. I eat pretty healthy already (lots of fruit and veggies, yogurts and lean proteins) so I’m not sure what to do. Could my body just need more time to get back to ovulating even though my periods came back? Have you heard of anyone having a similar story?

I would personally not go back on the pill, for a lot of reasons, least of which being that even if it alleviates symptoms in the short run, it still isn’t healing the underlying problems causing them in the first place. I would take a few months or a year to work on the bloating and acne via other methods, such as gut healing. And yes, your body may simply need more time. Most women’s bodies need a few cycles to adjust to changes in medications, diet, or environment. 🙂